Provider Demographics
NPI:1043754518
Name:CROSHAW, MARC CHASEN (PA)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:CHASEN
Last Name:CROSHAW
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:CALIENTE
Mailing Address - State:NV
Mailing Address - Zip Code:89008-1010
Mailing Address - Country:US
Mailing Address - Phone:775-726-3171
Mailing Address - Fax:775-726-3797
Practice Address - Street 1:700 N SPRING ST
Practice Address - Street 2:
Practice Address - City:CALIENTE
Practice Address - State:NV
Practice Address - Zip Code:89008-1010
Practice Address - Country:US
Practice Address - Phone:775-726-3121
Practice Address - Fax:775-726-3666
Is Sole Proprietor?:No
Enumeration Date:2016-12-18
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1043754518Medicaid